Download Anxiety Disorder lecture 1

Anxiety Disorders
Anxiety Disorders
1. Panic Disorder
2. Generalized Anxiety Disorder (GAD)
3. Phobias
Panic Anxiety Disorder
A. Recurrent unexpected panic attacks. A panic attack is
an abrupt surge of intense fear or intense discomfort
that reaches a peak within minutes, and during which
time four (or more) of the following symptoms occur:
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
Panic Anxiety Disorder
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or
depersonalization (being detached from oneself).
12. Fear of losing control or “going crazy.”
13. Fear of dying.
• Note: Culture-specific symptoms (e.g., tinnitus, neck
soreness, headache, uncontrollable screaming or crying)
may be seen. Such symptoms should not count as one
of the four required symptoms.
Panic Anxiety Disorder
B. At least one of the attacks has been followed by 1
month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic
attacks or their consequences.
2. A significant maladaptive change in behavior related
to the attacks.
Panic Anxiety Disorder
C. The disturbance is not attributable to the physiological
effects of a substance or another medical condition.
D. The disturbance is not better explained by another
mental disorder.
Panic Anxiety Disorder with
Agoraphobia
 If the condition is accompanied with excessive fear
from the attack to occur that is the person develops
phobic avoidance to situations in which a sense being
alone in public places from which escape might be
difficult or in which help is not available.
Panic Anxiety Disorder
• Prevalence
• In the general population, the 12-month prevalence
estimate for panic disorder across the United States
and several European countries is about 2%-3% in
adults and adolescents.
• Females are more frequently affected than males, at a
rate of approximately 2:1
• Suicide Risk
• Panic attacks and a diagnosis of panic disorder in the
past 12 months are related to a higher rate of suicide
attempts and suicidal ideation
• Functional Consequences of Panic Disorder
• Panic disorder is associated with high levels of social,
occupational, and physical disability.
Generalized Anxiety Disorder
Generalized Anxiety Disorder
A. Excessive anxiety and worry (apprehensive
expectation), occurring more days than not for at least 6
months, about a number of events or activities (such as
work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or
more) of the following six symptoms (with at least some
symptoms having been present for more days than not
for the past 6 months);
Generalized Anxiety Disorder
Note: Only one item is required in children.
1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep,
or restless, unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Generalized Anxiety Disorder
E. The disturbance is not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a
medication) or another medical condition (e.g.,
hyperthyroidism).
F. The disturbance is not better explained by another
mental disorder
Generalized Anxiety Disorder
• Prevalence
• The 12-month prevalence for the disorder in other
countries ranges from 0.4% to 3.6%.
• Females are twice as likely as males to experience
generalized anxiety disorder.
• Functional Consequences of Generalized Anxiety
Disorder
• Excessive worrying impairs the individual's capacity to
do things quickly and efficiently, whether at home or
at work. The worrying takes time and energy; the
associated symptoms of muscle tension and feeling
keyed up or on edge, tiredness, difficulty
concentrating, and disturbed sleep contribute to the
impairment.
Phobias
Phobias
• Irrational fear of an object, situation that is recognized
by the person as being unreasonable
• Types:
1. Agoraphobia
2. Specific Phobia
3. Social Phobia
Agoraphobia
A. Marked fear or anxiety about two (or more) of the
following five situations:
1. Using public transportation
2. Being in open spaces
3. Being in enclosed places
4. Standing in line or being in a crowd.
5. Being outside of the home alone.
B. The individual fears or avoids these situations
because of thoughts that escape might be difficult or
help might not be available in the event of developing
panic-like symptoms or other incapacitating or
embarrassing symptoms
Agoraphobia
C. The agoraphobic situations almost always provoke
fear or anxiety.
D. The agoraphobic situations are actively avoided,
require the presence of a companion, or are endured
with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual
danger posed by the agoraphobic situations and to the
sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically
lasting for 6 months or more.
Agoraphobia
G. The fear, anxiety, or avoidance causes clinically
significant distress or impairment in social, occupational,
or other important areas of functioning.
H. If another medical condition is present, the fear,
anxiety, or avoidance is clearly excessive.
I. The fear, anxiety, or avoidance is not better explained
by the symptoms of another mental disorder.
Note: Agoraphobia is diagnosed irrespective of the
presence of panic disorder.
Agoraphobia
• Functional Consequences of Agoraphobia
• Agoraphobia is associated with considerable
impairment and disability in terms of role functioning,
work productivity, and disability days.
Specific Phobia
D. The fear or anxiety is out of proportion to the actual
danger posed by the specific object or situation and to
the sociocultural context.
E. The fear, anxiety, or avoidance is persistent, typically
lasting for 6 months or more.
F. The fear, anxiety, or avoidance causes clinically
significant distress or impairment in social, occupational,
or other important areas of functioning.
Specific Phobia
A. Marked fear or anxiety about a specific object or
situation (e.g., flying, heights, animals, receiving an
injection, seeing blood).
Note: In children, the fear or anxiety may be expressed by
crying, tantrums, freezing, or clinging.
B. The phobic object or situation almost always provokes
immediate fear or anxiety.
C. The phobic object or situation is actively avoided or
endured with intense fear or anxiety.
About Specific Phobia
• The average individual with specific phobia fears
three objects or situations, and approximately 75% of
individuals with specific phobia fear more than one
situation or object
• Prevalence:
• In the United States, the 12-month community
prevalence estimate for specific phobia is
approximately 7%-9%. but rates are generally lower
in Asian, African, and Latin America
• Females are more frequently affected than males, at
a rate of approximately 2:1, although rates vary
across different phobic stimuli.
Specific Phobia
• Specific phobia sometimes develops following:
1. a traumatic event
2. observation of others going through a traumatic
event
3. an unexpected panic attack in the to be feared
situation
4. or informational transmission
• However, many individuals with specific phobia
are unable to recall the specific reason for the
onset of their phobias.
Social Anxiety Disorder (Social Phobia)
A. Marked fear or anxiety about one or more social
situations in which the individual is exposed to
possible scrutiny by others.
• Examples include social interactions (e.g., having
a conversation, meeting unfamiliar people), being
observed (e.g., eating or drinking), and
performing in front of others (e.g., giving a
speech).
• Note: In children, the anxiety must occur in peer
settings and not just during interactions with
adults.
Social Phobia
B. The individual fears that he or she will act in a way or
show anxiety symptoms that will be negatively evaluated
(i.e., will be humiliating or embarrassing: will lead to
rejection or offend others).
C. The social situations almost always provoke fear or
anxiety.
Note: In children, the fear or anxiety may be expressed
by crying, tantrums, freezing, clinging, shrinking, or
failing to speak in social situations.
D. The social situations are avoided or endured with
intense fear or anxiety.
Social Phobia
E. The fear or anxiety is out of proportion to the actual
threat posed by the social situation and to the
sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically
lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically
significant distress or impairment in social, occupational,
or other important areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to
the physiological effects of a substance or another
medical condition.
Social Phobia
I. The fear, anxiety, or avoidance is not better
explained by the symptoms of another mental disorder
J. If another medical condition the condition is worsened
Social Phobia
• Prevalence
• The 12-month prevalence estimate of social
anxiety disorder for the United States is
approximately 7%.
• Lower 12-month prevalence estimates are seen
in much of the world around 0.5%-2.0.
• Functional Consequences of Social Anxiety
Disorder
• Social anxiety disorder is associated with
elevated rates of school dropout and with
decreased well-being, employment, workplace
productivity, socioeconomic status, and quality of
life.
Social Phobia
• Comorbidity
• Social anxiety disorder is often comorbid with
other anxiety disorders, major depressive
disorder, and substance use disorders.
Obsessive-Compulsive and
Related Disorders.
Obsessive-Compulsive Disorder
A. Presence of obsessions, compulsions, or both:
• Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or images
that are experienced, at some time during the
disturbance, as intrusive and unwanted, and that in most
individuals cause marked anxiety or distress.
2. The individual attempts to ignore or suppress such
thoughts, urges, or images, or to neutralize them with
some other thought or action.
Obsessive-Compulsive Disorder
• Compulsions are defined by (1) and (2):
• 1. Repetitive behaviors (e.g., hand washing,
ordering, checking) or mental acts (e.g., praying,
counting, repeating words silently) that the
individual feels driven to perform in response to an
obsession or according to rules that must be applied
rigidly.
• 2. The behaviors or mental acts are aimed at
preventing or reducing anxiety or distress, or
preventing some dreaded event or situation;
however, these behaviors or mental acts are not
connected in a realistic way with what they are
designed to neutralize or prevent, or are clearly
excessive.
Obsessive-Compulsive Disorder
Note: Young children may not be able to articulate the
aims of these behaviors or mental acts.
B. The obsessions or compulsions are time-consuming
(e.g., take more than 1 hour per day) or cause clinically
significant distress or impairment in social, occupational,
or other important areas of functioning.
C. The obsessive-compulsive symptoms are not
attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication) or another medical
condition.
D. The disturbance is not better explained by the
symptoms of another mental disorder
Obsessive-Compulsive Disorder
• Prevalence
• The 12-month prevalence of OCD in the United States is
1.2%, with a similar prevalence internationally (1.1%1.8%).
• Females are affected at a slightly higher rate than males
in adulthood, although males are more commonly
affected in childhood.
• Suicide Risk
• Suicidal thoughts occur at some point in as many as
about half of individuals with OCD. Suicide attempts are
also reported in up to one-quarter of individuals with
OCD; the presence of comorbid major depressive
disorder increases the risk.
Obsessive-Compulsive Disorder
• Functional Consequences of Generalized Anxiety
Disorder
• Excessive worrying impairs the individual's capacity to
do things quickly and efficiently, whether at home or at
work. The worrying takes time and energy; the
associated symptoms of muscle tension and feeling
keyed up or on edge, tiredness, difficulty concentrating,
and disturbed sleep contribute to the impairment.
Body Dysmorphic Disorder
Body Dysmorphic Disorder
• A. Preoccupation with one or more perceived defects or
flaws in physical appearance that are not observable or
appear slight to others.
• B. At some point during the course of the disorder, the
individual has performed repetitive behaviors (e.g.,
mirror checking, excessive grooming, skin picking,
reassurance seeking) or mental acts (e.g., comparing his
or her appearance with that of others) in response to the
appearance concerns.
• C. The preoccupation causes clinically significant
distress or impairment in social, occupational, or other
important areas of functioning.
Body Dysmorphic Disorder
• D. The appearance preoccupation is not better explained
by concerns with body fat or weight in an individual
whose symptoms meet diagnostic criteria for an eating
disorder.
• Prevalence
• The point prevalence among U.S. adults is 2.4% (2.5%
in females and 2.2% in males).
• Suicide Risk
• Individuals with body dysmorphic disorder have many
risk factors for completed suicide, such as high rates of
suicidal ideation and suicide attempts, demographic
characteristics associated with suicide, and high rates
• of comorbid major depressive disorder.
Body Dysmorphic Disorder
• Functional Consequences of Body Dysmorphic
Disorder
• Nearly all individuals with body dysmorphic disorder
experience impaired psychosocial functioning because
of their appearance concerns. Impairment can range
from moderate (e.g., avoidance of some social
situations) to extreme and incapacitating (e.g., being
completely housebound).
Trauma and Stressor-Related Disorders
Posttraumatic Stress Disorder
Note: The following criteria apply to adults,
adolescents, and children older than 6 years. For
children 6 years and younger, see corresponding
criteria below.
A. Exposure to actual or threatened death, serious injury,
or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to
others.
3. Learning that the traumatic event(s) occurred to a
close family member or close friend. In cases of actual or
threatened death of a family member or friend, the
event(s) must have been violent or accidental.
Posttraumatic Stress Disorder
4. Experiencing repeated or extreme exposure to
aversive details of the traumatic event(s) (e.g., first
responders collecting human remains: police officers
repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through
electronic media, television, movies, or pictures, unless
this exposure is work related.
B. Presence of one (or more) of the following intrusion
symptoms associated with the traumatic event(s),
beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing
memories of the traumatic event(s).
Posttraumatic Stress Disorder
2. Recurrent distressing dreams in which the content
and/or affect of the dream are related to the traumatic
event(s).
Note: In children, there may be frightening dreams
without recognizable content.
3. Dissociative reactions (e.g., flashbacks) in which the
individual feels or acts as if the traumatic event(s) were
recurring. (Such reactions may occur on a continuum,
with the most extreme expression being a complete loss
of awareness of present surroundings.)
Note: In children, trauma-specific reenactment may
occur in play.
Posttraumatic Stress Disorder
4. Intense or prolonged psychological distress at
exposure to internal or external cues that symbolize or
resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to internal or external
cues that symbolize or resemble an aspect of the
traumatic event(s).
Posttraumatic Stress Disorder
C. Persistent avoidance of stimuli associated with
the traumatic event(s), beginning after the traumatic
event(s) occurred, as evidenced by one or both of
the following:
1. Avoidance of or efforts to avoid distressing memories,
thoughts, or feelings about or closely associated with the
traumatic event(s).
2. Avoidance of or efforts to avoid external reminders
(people, places, conversations, activities, objects,
situations) that arouse distressing memories, thoughts,
or feelings about or closely associated with the traumatic
event(s).
Posttraumatic Stress Disorder
D. Negative alterations in cognitions and mood
associated with the traumatic event(s), beginning or
worsening after the traumatic event(s) occurred, as
evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the
traumatic event(s) (typically due to dissociative
amnesia and not to other factors such as head injury,
alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or
expectations about oneself, others, or the world (e.g., “I
am bad,” “No one can be trusted,” ‘The world is
completely dangerous,” “My whole nervous system is
permanently ruined”).
Posttraumatic Stress Disorder
3. Persistent, distorted cognitions about the cause or
consequences of the traumatic event(s) that lead the
individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror,
anger, guilt, or shame).
5. Markedly diminished interest or participation in
significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions
(e.g., inability to experience happiness, satisfaction, or
loving feelings).
Posttraumatic Stress Disorder
E. Marked alterations in arousal and reactivity
associated with the traumatic event(s), beginning
or worsening after the traumatic event(s) occurred,
as evidenced by two (or more) of the following:
1. Irritable behavior and angry outbursts (with little or no
provocation) typically expressed as verbal or physical
aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying
asleep or restless sleep).
Posttraumatic Stress Disorder
F. Duration of the disturbance (Criteria B, C, D, and E) is
more than 1 month.
G. The disturbance causes clinically significant distress
or impairment in social, occupational,
or other important areas of functioning.
H. The disturbance is not attributable to the physiological
effects of a substance (e.g., medication, alcohol) or
another medical condition.
Posttraumatic Stress Disorder
3. Persistent, distorted cognitions about the cause or
consequences of the traumatic event(s) that lead the
individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror,
anger, guilt, or shame).
5. Markedly diminished interest or participation in
significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions
(e.g., inability to experience happiness, satisfaction, or
loving feelings).